- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,054.52 / $3,748.00 / $8,017.00
| Facility | | $1,054.52 | $3,748.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $893.66 / $987.54 / $1,225.48
| Professional | | $893.66 | $987.54 | $1,225.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,639.91 / $11,851.00 / $28,970.26
| Facility | | $8,639.91 | $11,851.00 | $28,970.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $999.24 / $1,036.95 / $1,036.95
| Professional | | $999.24 | $1,036.95 | $1,036.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.47 / $1,084.08 / $1,830.51
| Professional | | $794.47 | $1,084.08 | $1,830.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,195.38 / $1,536.92 / $1,590.73
| Professional | | $1,195.38 | $1,536.92 | $1,590.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,013.00 / $3,964.00 / $8,017.00
| Facility | | $1,013.00 | $3,964.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $917.38 / $1,119.00 / $5,287.32
| Professional | | $917.38 | $1,119.00 | $5,287.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,040.80 / $1,040.80 / $1,092.80
| Professional | | $1,040.80 | $1,040.80 | $1,092.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,127.85 / $1,127.85 / $1,127.85
| Facility | | $1,127.85 | $1,127.85 | $1,127.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $867.78 / $1,106.41 / $1,954.77
| Professional | | $867.78 | $1,106.41 | $1,954.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $962.13 / $974.77 / $974.77
| Facility | | $962.13 | $974.77 | $974.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $962.13 / $974.77 / $1,031.72
| Professional | | $962.13 | $974.77 | $1,031.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,843.00 / $3,879.00 / $7,508.00
| Facility | | $1,843.00 | $3,879.00 | $7,508.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $829.18 / $1,100.82 / $1,904.32
| Professional | | $829.18 | $1,100.82 | $1,904.32 |